Revenue Cycle

Recovery auditor hot topics: esMD

Recovery Auditor Report, March 8, 2012

The following article is part one in a series covering various topics in the world of recovery auditors. Part one will focus on CMS’ esMD (Electronic submission of medical documentation) program.

A year ago this month, CMS announced its esMD tool, which is an option for providers to electronically send medical documentation that is requested of them by recovery auditors and other government entities contractors. This article will take a look at the advances the esMD program has made since then, and what providers should expect of it going forward.

Who is accepting esMD?

Phase 1 of esMD kicked off on September 15, 2011, and during this period, providers will still receive medical documentation requests via paper mail, but will have the option to electronically send their documentation to the requesting review contractor. As of September 2011, the following review contractors have been approved to participate in the esMD program:

  • Region A Medicare recovery audit  (DCS)
  • Region B Medicare recovery audit  (CGI)
  • Medicare administrative J1 (Palmetto GBA)
  • Medicare administrative J3 (Noridian)
  • Medicare administrative J4 (Trailblazer)
  • Medicare administrative J5 (WPS)
  • Medicare administrative J9 (First Coast)
  • Medicare administrative J11 (Palmetto)
  • Medicare administrative J12 (Highmark)
  • Medicare administrative J14 (NHIC)
  • Comprehensive error rate testing (CERT) contractor
  • Program error rate measurement (PERM) contractor
  • DME Medicarea JA (NHIC)
  • DME Medicare administrative JD (Noridian)
  • Medicare administrative J13 (NGS)
  • DME Medicare administrative JB (NGS)
  • Medicare administrative J10 (Cahaba)

Region D recovery auditor HealthDataInsights plans to participate in the program starting this month, and Region C recovery auditor Connolly next month.

 Continue reading.

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